There is a need for community-based, culturally sensitive, cognitive-behavioral interventions to reduce sexual risk behavior among minority adolescent women for prevention of STI/HIV, substance use, unintended pregnancy and abuse (160-176). Studies of risk and protective behaviors of adolescent women have focused on identifying modifiable psychosocial variables that predict differential outcomes for subsequent intervention efforts. Research has been scarce in studies of rural Mexican-American adolescent women (RMMA). This study proposes translation of behavioral interventions developed in control randomized trials, "Behavioral Intervention for Minority Adolescent Women" and "Modifying Risk Behavior of Minority Women," (Project SAFE) (121-125). These studies designed and evaluated culturally relevant, minority-women-specific STI-clinic based interventions for inner city adolescent women with a history of abuse and STI. The interventions based upon the AIDS Risk Reduction Model (ARRM) are grounded in knowledge of the target populations' behavior and culture, use STI, substance use, unintended pregnancy, abuse recurrence and detailed measures of sexual behavior as primary outcome variables. Results demonstrate participants receiving the intervention are significantly less likely to be re-infected with STI, have decreased substance use, unintended pregnancy and abuse recurrence. This study proposes translation of these interventions through a community-based control- randomized trial focused on reducing rates of STI/HIV, unintended pregnancy and sexual or physical abuse and substance use among RMAA by changing high-risk sexual behaviors, decreasing substance use and encouraging contraceptive use. Its goal is to translate the risk-reduction interventions created in our prior studies for this particularly vulnerable and high-risk group. A community-based adolescent intervention has been developed and pilot-tested for this rural population. Specific aims include: 1) to implement a controlled randomized trial of a cognitive behavioral intervention for RMAA women consisting of small group sessions, individual counseling and post-intervention support groups. We will evaluate the effects of the adolescent intervention model versus enhanced counseling for RMAA women. Primary outcomes are substance use, new infection with STI, unintended pregnancy and abuse recurrence at 6, 12, 18 and 24 month follow-up. Secondary outcomes include high-risk sexual behavior and contraceptive use, and 2) to obtain an understanding of psychosocial and situational factors that are associated over time with substance use, abuse occurrence, unintended pregnancy and STI/HIV among RMAA women. We want to understand the broader context in which substance use, abuse, unintended pregnancy and infection occur. Participants will include a convenience sample of 500 RMAA, aged 13-19 years accessing services at 5 rural health clinics in the Texas- Mexico border region. PUBLIC HEALTH RELEVANCE: Interventions that modify risk behavior and substance use may reduce unintended pregnancy, sexual or physical abuse and STI/HIV among rural Mexican- American adolescent women, a particularly vulnerable, at-risk population.